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CLINICAL CHEMISTRY, What produces Hormones stimulate specific cells or…

- - - - ADH
      - OXYTOCIN
    - - PROLACTIN
        by lactotrophs/ mammotrophs
      - GH
        by somatotrophs
        
        Stimuli:
        → Major: deep sleep 😴
        → Physiologic: stress, fasting, high protein diet
        → Pharmacologic: sex steroid, levodopa, apomorphine
        
        ⬆️
        
        Acromegaly (> 50ng/mL or 2210 picomol/L)
        
        Chronic malnutrition
        
        Renal dse
        
        Cirrhosis
        
        Sepsis
        
        DIAGNOSTIC TESTS 🩺
        For acromegaly:
        
        Screening: Somatomedin or Insulin-like growth factor 1 (IGF-1)
        → IGF-1: ⬆ in px w acromegaly, ⬇ GHD
        
        Confirmatory: OGTT (75g glucose)
        → 3 samples: (1) fasting, (2) 1st hr, (3) 2nd hr
        
        Suppressors
        → Major: Somatostatin
        → > FAs, Glucocorticoids = > cortisol
        
        ⬇️
        
        GH Deficiency
        → A. Idiopathic GHD cause: common in children
        → B. Pituitary adenoma: common in adults
        
        Hyperglycemia
        
        Obesity
        
        Hypothyroidism
        
        DIAGNOSTIC TESTS 🩺
        For GHD:
        
        Screening: physical act/ exercise test???
        → Normal: elevated serum GH
        → if Decreased: perform confirmatory
        
        Confirmatory:
        
        Insulin tolerance test – gold standard 🏆
        
        Arginine stimulation test – 2nd confirmatory 🥈
        
        Interpretation: fail to rise >5ng/mL @ adults > 10ng/mL @ child = GHD duhh
      - Gonadotrophin
        by gonadotrophs
        
        FSH
        [spermatogenesis]
        
        ⬆️
        
        FSH only: premature menopause
        Both FSH & LH after menopause:
        lack of estrogen
        
        LH
        for males – ↑ testosterone from leydig cells
        for females – ovulation & final follicular growth
        **acts on thecal cells = androgens, estroens, progesterone
        
        Highest at the MIDPOINT of the cycle
      - TSH
        by thyrotrophs
        
        stimulates uptake of iodide by thyroid gland
        
        2 subunits:
        a subunit: same AA sequence as LH, FSH, HCG
        B subunit: carries specific information to binding receptors
        determines the specific biological and immunological properties of the hormone
      - ACTH
        by corticotrophs
        
        produced in response to LOW serum cortisol
        
        ⬆️
        
        ⬇️
      - The
        Great
        Anterior
        Pituitary
        Gland
- - - - PLS PASTE HERE ABE PLEASE THANK YOU
        
        ⬇️ HYPOTHYROIDISM
        
        Secondary
        Pituitary dysfunction
        
        LOW T3 & T4
        LOW TSH
        
        Primary
        Thyroid gland dysfunction
        
        LOW T3 & T4
        HIGH TSH
        
        Thyroidectomy/ Thyroid surgery
        
        Iodine deficiency
        
        Radioactive Iodine
        
        Hashimoto’s/
        Chronic Lymphocytic Thyroiditis
        
        TPOAb**
        TgAb
        
        Tertiary
        Hypothalamic dysfunction
        
        ⬆️ HYPERTHYROIDISM/
        
        THYROTOXICOSIS
        
        Secondary
        PItuitary excessive production (TSH)
        
        HIGH T3 & T4
        HIGH TSH
        
        TSH-secreting tumor
        
        Tertiary
        Hypothalamic excessive production (TRH)
        
        Primary
        Thyroid gland excessive production
        
        HIGH T3 & T4
        LOW TSH
        
        Toxic adenoma
        
        Grave’s disease/
        Basedow’s disease
        Diffuse Toxic Goiter
        
        TSHRAbs**
        TPOAbs
        TgAbs
        
        Thyroglobulin (Tg)
        
        1 more item...
        
        Toxic multinodular goiter
- - - - Glucocorticoids
    - - Sex hormones
    - - Mineralocorticoids
  - - - Epinephrine
      - Norepinephrine
- - - - Alpha
        common to all
      - Beta
        give own biologic activity
- - - - Half Life: 20-70 Hrs
        
        induces GABA (inhibits dopaminergic neurons)
  - - - through nasal = Snorting
        Local anesthesia for nasopharyngeal surgery
        Not considered as an addictive drug (Torrento)
        Treatment: Benzodiaziepine
        Metabolite: Benzoylecgonine
        
        TOXICITY
        
        Neurotoxicity
        
        Metabolism of cocaine in liver = N-oxide (Amine Oxide)
        
        Cardiotoxicity
        (Sudden death)
        
        ⬆️ CK-MB
        
        MI
        
        Constriction of coronary artery
    - - Same effect kay DOPAMINE
        Inhibits MOA (monoamine oxidase) --> Inactivates adrenergic neurotransmitters
        ☠️ Tongue/Lips Ulcer
        💊Propanolol
        Derivative: 3,4 methylenedioxymethamphetamine (MDMA or Ecstasy)
  - - - Propoxyphene
        AKA Darvon
        
        similar to morphine
        analgesic
      - Methadone
        
        also attaches sa micro receptors of brain
        Non Bicyclic Drug
    - - Mild Analgesic
        Platelet aggregation
        
        Vasoconstriction
        
        Synthesis of plasminogen activator inhibitor
    - - Effects
        
        Withdrawal:
        
        Palpitation
        
        Cold sweat
        
        Hypothermia
        
        Kung adik pa:
        Vasodilation
        Pupil Constriction
      - Half Life: 3min.
        
        Antidote: Nalaxone (Narcan)
      - Metabolites nya
        
        Morphine
        
        N-Acetylmorphine
    - - Half Life: 3Hrs
        
        Strong Analgesic
        
        binds to micro receptors of brain
        
        bulong' for CHF
  - - - Ultra short
        
        Thiopental
      - Short acting
        
        Pentobarbital
      - Intermediate
        
        Amobarbital
      - Long acting
        
        Phenobarbital
        
        Anti-seizure
        Primidone: inactive proform
        
        Phenytoin
        (anti-convulsant; antiepileptic)
        Tradename: Dilantin
- - - - Supertoxic substance
        Pyrolysis
        Heme & Cytochrome
        Urinary thiocyanate
        Hallmark of cyanide toxicity? Odor of bitter almonds breath
      - Additional notes
        
        Spectrophotometry:
        Whole blood + Strong acid ➡️ Hydrocyanic acid
        Hydrocyanic acid + Strong base ➡️ Red complex
    - - Carboxyhemoglobin: Cherry-red
        300x affinity than oxygen = tissue hypoxia
      - Additional notes
        
        Gas chromatography: Whole blood + Potassium ferricyanide
    - - Cadmium
        
        Itai itai disease
        Electroplating & galvanizing (Mining)
        Type 1 epithelial cell destruction
        Renal tubular dysfunction
        
        Electrothermal Atomic Absorption Spectrophotometry
        (AAS)
      - Lead
        
        Basophilic stippling PBS = treat w EDTA
        Enzyme inhibition: Vit D & Heme
        Blocks the enzymes:
        Delta aminolevulinic Acid Synthase
        Pyrimidine 5’ nucleotidase
        Na K ATPase
      - Arsenic
        
        Garlic odor breath
        Mees’ lines: white lines sa fingernails
        Short term: blood & urine
        Long term: nails & hair
      - Mercury
        
        Inhibits Catecholamine O Methyl Transferase (COMT)
        (1) Acrodynia (pink discoloration of the body) & Erethism/Mad Hatter Disease
        (2) Congenital Minamata Disease
        Has the ability to amalgamate: bind or merge with other substances
    - - Acetylcholinesterase (AChE): Confirmatory test
        
        major role in skeletal muscle/ contraction (movement)
      - Pseudocholinesterase (SChE): Screening test
      - Additional notes:
        
        Cholinesterase assays
        (1) Michel method/ pH change
        (2) Ellman Method/ Colorimetric:
        Cholinesterase + Thiol ester ➡️ Thiolcholine
        Thiolcholine + Dithiobis-Nitrobenzoic Acid (DNBA)
  - - - Wood alcohol
        Fruity odor breath
        Formic acid: metabolic acidosis
        Blindness/ optic neuropathy
    - - Rubbing alcohol
        Acetone
        CNS depression
    - - Grain alcohol
        Acetic/ lactic acid: elevated lactate levels
        Intake during pregnancy: Fetal Alcohol Syndrome
        Marker for alcohol abuse? GGT (markedly elevated)
    - - Oxalic & Glycolic acid
        Hydraulic fluid & anti-freeze
        [Monohydrate] CaOx deposition
    - - Best specimen: whole blood
        
        Alcohol-free disinfectant
        
        Sodium fluoride
        
        Gas chromatography
        
        Alcoholic cirrhosis: slightly elevated AST/ ALT, ALP
        Markedly elevated: GGT
- - - - Angiotensin 1
        
        Angiotensin 2
        
        Aldosterone
        
        Angio 2 stimulates adrenal cortex to produce...
        
        Angiotensin converting enzyme (ACE)
        
        damo sa lungs
      - RENIN
- - - - SENSITIVITY
        
        SPECIFICITY
        
        Specific to analyte, no false detections
        
        TRUE NEGATIVE
        
        TN/(TN+FP)x100⭐
        
        CV, SD, Mean
        
        SD
        
        THE HIGHER THE SD, THE LOWER THE
        PRECISION
        
        Mean
        
        "mean" refers to the average
        value of a set of control measurements
        
        Next topic🎉
        
        1 more item...
        
        CV
        
        THE HIGHER THE CV, THE LOWER THE
        PRECISION
        
        Percentile expression of mean⭐
        
        SD/Mean x 100⭐
        
        Detects smallest amount of analyte
        
        lead to TRUE POSITIVE
        
        TP/(TP+FN)x100⭐